Self-mutilation isn't exactly a dinner-table topic. But cutting and piercings and self-harm are a growing phenomenon that parents and concerned family and friends simply cannot ignore. The problem is becoming more common among young people who lack self-esteem, have dysfunctional family situations, are experiencing extreme stress or pressure at school, or may have underlying mental and\/or physical conditions. Whatever the reason for the cutting, when it does occur, it's more than just a means of getting attention. Underneath it all is a profound cry for help. Who Cuts? It's easy to say that only a certain element of the population engages in this type of behavior, but that would be simplistic and wrong. There's no way to pinpoint exactly who is a cutter and who isn't, from the standpoint of generalizations. A cutter can be a male or a female, so there's no saying that one will do it more than the other. All you have to do is look at the number of individuals you see on the streets at any given time and it's easy to see that people with piercings, multiple tattoos, scars, cuts and other forms of self-harm are equally male and female. It's also true that cutters can come in all ages, although the behavior typically begins when the person is young, usually adolescence. Some cutters will continue to engage in self-harm for most of their lives, only ceasing the behavior when they get treatment, perhaps for drug or alcohol abuse where the self-mutilation is dealt with on a co-occurring mental health disorder and treated simultaneously with the substance abuse. Your own son or daughter, or sister or brother, other relative or friend or neighbor can be a cutter. You simply never know who it might be. The truth is that cutters live among us. And they try desperately to keep you from knowing anything about what they do to themselves in private to cause harm. Why Do People Cut? An obvious question that many of us would like the answer to is why in the world anyone would ever deliberately inflict pain by cutting themselves? This is not an easy answer for several reasons. First, why does anyone engage in any type of behavior? It's a highly personalized trigger and likely based on unique circumstances. While some cutters have similar backgrounds and characteristics - dysfunctional family circumstances, living in poverty, drug and alcohol use, history of emotional difficulties and\/or mental conditions - what causes one person to cut and not another can seem quixotic. Generally speaking, cutting results from the confluence of a number of factors. It's a case of the perfect storm. When things build up to a certain point, there's only one release that the cutter knows he or she can turn to and that is cutting. Cutters often say that when they feel empty emotionally, cutting is the only way they can feel something. Even though that something is pain, it is something they feel. Cutters also may want to punish themselves by inflicting self-harm, or to manipulate others. Deliberate infliction of pain is something that the cutter controls. He or she knows exactly how much to cut, and where and when. The spurt of blood, the sharp pain, the barely healed scars are all tangible signs that the cutting has done its job. The physical pain is one way to take the mind off other problems, while the scars are the reminder that the person has control over his or her body. Cutting is also an act of rebellion, like the young person saying by his or her actions that no one can tell me what to do. But it isn't only the kids from uptight, straight-laced or ultra-conservative families that cut. Kids that seemingly have it all - great parents, well-to-do families, good health, etc. - also engage in cutting. Pain to Stop the Pain It might seem counter-intuitive that a person would cut to stop the pain. Isn't the concept of deliberately inflicting self-pain in order to stop pain like a contradiction in terms? In reality, though, as previously mentioned, the cutter is well aware of just how much pain he or she can tolerate. Cutting is a ritual that is performed almost as a Pavlovian response to pain, whether that pain is emotional, physical, psychological or social in nature. Cutting helps the individual to temporarily block out everything else, to concentrate on the exquisite self-torture and relief that cutting brings. It does sound ridiculous to those of us who cannot possibly imagine engaging in such behavior, but what we think or feel about cutting is really irrelevant. In fact, our own preconceived notions about cutting and cutters will stand in the way of us doing what we can and should to help the individual engaging in such behavior. Spotting the Signs How do you really know if someone you care about is a cutter? Some of the signs will be obvious, if the cutter cannot cover them up or chooses not to. But others require some piecing together. Here are some of the common signs that an individual may be engaged in cutting. Cutters frequently have visible scars, perhaps from burns, but mostly from cuts. \tAlong with scars, cutters will often have fresh cuts or scratches, along with bruises and other types of wounds (including infected wounds). \tBroken bones may also be a symptom that an individual is engaged in self-harm. \tIf a person constantly wears long-sleeved garments or pants, even during hot weather, it may be a sign that they're trying to cover up evidence of cutting. \tSomeone who cuts may claim that injuries are the result of accidents or mishaps. \tCutters may have relationship problems and spend a great deal of time alone. \tThe constant presence of sharp objects is another danger sign that a person may be a cutter. Ignoring it Won't Make it Go Away As with substance abuse, the temptation to ignore signs of cutting in young people or others is not going to make the behavior go away. If anything, if a cutter knows that you know about what is going on and won't do anything about it, the behavior will only continue. You may think that if you say something about it and try to find out what's bothering the individual that it will only cause them to clam up. While this may be true, it doesn't mean that you're excused from your responsibility (especially if you are the parent or caregiver) to do all you can to help the person. Getting back to the crux of the matter, cutting is a cry for help - even if the person doing the cutting is adamantly opposed to any outside interference. What Should You Do? Let's say that you know of a cutter, or your own child or spouse or loved one engages in cutting. What should you do? Or, more specifically, what should you do first? How to help a cutter is a problem that's best approached carefully and strategically. You don't want to alarm the individual or cause the cutter to go off the deep end, literally. But you do need to employ a well-thought-out strategy for dealing with the situation and getting help for the cutter. Naturally, you feel shock and maybe even fear - for the cutter as well as for yourself and other members of the family. You need to learn more about cutting so that you can better understand why it occurs. Gaining knowledge about cutting and self-injury will allow you to develop a more compassionate and firm approach to help the person stop such harmful behavior. Risks and Complications of Cutting While there's no absolute way to pinpoint who will be a cutter, there are certain risk factors that come into play. One risk factor alone doesn't necessarily mean an individual will resort to cutting, but coupled with other risk factors, there's a definite possibility that cutting will be either contemplated or become part of the person's behavior. In the case of cutting, age may be a risk factor. Cutting often begins in the early teen years when children are experiencing volatile emotions, are under intense peer pressure, feel lonely and have conflicts with parents and other figures of authority. \tAbuse, sexual, physical or mental, being neglected in childhood - these are other risk factors for cutting. \tIf an individual has friends (peers) who injure themselves, this may seem like normal activity within that circle. A person with friends that cut is more at risk to begin cutting themselves. \tMental health issues put individuals at the highest risk of becoming cutters. These particularly include those who are highly self-critical and frequently experience negative emotions. Impulsive individuals, those with poor problem-solving skills, and those with certain mental illnesses (borderline personality disorder, post-traumatic stress disorder, substance abuse, depression, anxiety, and eating disorders are also at risk for becoming cutters and self-injurers. \tAnother risk factor common among cutters is substance abuse. Whether the substance abused is alcohol or drugs or some combination thereof, while under the influence, the risk is magnified that the individual will attempt self-harm, including cutting. Complications arising from cutting include the following: \tThe cutter suffers worsening feelings of guilt, shame and lowered self-esteem. \tThe cutter may have infections as a result of the cutting or from sharing cutting implements with others. \tThe cutter may have a life-threatening problem, such as massive blood loss, caused by the accidental (or deliberate) cutting of an artery or major blood vessels. \tThe cutter may have to live with permanent scars or disfigurement. \tThe cutter may accidentally or deliberately commit suicide. Cutters under the influence of alcohol or drugs or multiple substances may not intend to kill themselves, but while engaged in cutting, they're not in complete control of their faculties and could easily injure themselves fatally. Treatment for Cutters and Self-Harm Treatment for self-injury, including cutting, is personalized to the individual. For this reason, there is no one treatment that works for every individual. Cutting, especially, can become a major part of a person's life. In fact, it is often accompanied by mental disorders, some of which may be serious. This requires treatment by a mental health professional who's highly experienced in the treatment of self-injury. \tPsychotherapy - Also called talk therapy, psychotherapy is one of the treatment options that may be employed for cutting and self-injury. Such therapy seeks to indentify the underlying issues that trigger cutting and to help manage them. Through psychotherapy, the cutter can learn skills to better manage stress, improve self-image, regulate emotions, and improve relations and problem-solving. Types of psychotherapy that may be utilized include cognitive behavioral therapy (CBT), psychodynamic psychotherapy, and dialectical behavioral therapy. In addition, group therapy and\/or family therapy may be recommended. \tMedications - There are no medications specifically designed for the treatment of cutting or self-injury. But the cutter's doctor may prescribe antidepressants or other types of psychiatric medications as part of the overall treatment to help the patient manage symptoms of depression, anxiety, or other forms of mental health disorder commonly occurring with self-injury. The concept behind treating with medications is that when the cutter begins to feel better about his or her self-image, they're less likely to want to continue to inflict self-harm. \tHospitalization (psychiatric) - In extreme cases, where the cutter is deemed to be a threat to himself or herself, psychiatric hospitalization may be required. Repeated and\/or severe instances of cutting may make this a necessity. The constant monitoring and more intensive treatment available at a psychiatric hospital can help the cutter get through a crisis. Such treatment may also be available at day-treatment facilities. Tips on Coping with a Loved One's Cutting There's no question that the cutter needs to get professional help. Parents, family members and loved ones and friends can also benefit from making use of proven coping methods. It's important not to be judgmental about the cutter's behavior or lifestyle. This does absolutely no good and can exacerbate the situation and jeopardize the person's healing process. If the cutter is your child or loved one, the most important thing to remember is to let the person know that you love him or her regardless. Your love is not conditional. You will always love the person. It's important that you say this often and that you mean what you say. The cutter needs to hear it and believe you - even if they profess that they don't care. They really do. It's stressful for you to go through a period where the cutter is undergoing treatment or is in recovery from cutting. You can't be expected to just swallow your feelings and confusion. You may need someone to talk to about what's going on, how to better cope with the situation, and to familiarize yourself with effective strategies you may be able to use later on in the cutter's healing and recovery process. The cutter's therapist or doctor may be able to recommend local support or self-help groups for the parents and other loved ones of cutters. If You Suspect Cutting, Answer the Cry for Help In the end, if you suspect that someone you love - your child, spouse, loved one or friend - is engaging in cutting behavior, you owe it to that person and to yourself to answer the cry for help. It is most likely a covert cry, one that the cutter doesn't even know is being issued, but it is a plea for assistance nonetheless. You don't have to be a bully about helping the individual. Rather, learn all you can about cutting and self-injury and inquire from a medical professional the best way to enlist help for the cutter. The reality is that unless cutters do get treatment to learn how to deal with their emotional distress, lack of self-esteem and other issues, cutting behavior will continue. It is a difficult, but not impossible, habitual behavior to overcome. Being loving and supportive during the individual's treatment and healing and recovery process is one of the best things you can do. But, above all, do it now. There's literally no time to waste, not when the very life of the person you care about may be in jeopardy.